OVERVIEW

In June of 2017, the British Columbia Centre on Substance Use (BCCSU) became responsible for the education and training pathways and clinical care guidance for prescribers of opioid use disorder treatment in BC. Amidst a provincial overdose crisis, British Columbia made concerted efforts to address gaps in the provision of evidence-based treatment options and care for individuals with opioid use disorder, including the development of provincial guidelines (BCCSU/MoH Guidelines for the Clinical Management of Opioid Use Disorder) as well as the creation of its aligned training program, the Provincial Opioid Addiction Treatment Support Program. This comprehensive training program includes education and training prescribing opioid agonist treatments, which includes buprenorphine/naloxone, methadone, slow-release oral morphine, and injectable opioid agonist treatments (hydromorphone and diacetylmorphine).

In order to improve access and provincial capacity for opioid agonist treatment education for health professionals, the BCCSU (in partnership with UBC CPD) developed an online learning platform paired with an in-person preceptorship. The online course is free and available for anyone to register – not just those seeking to prescribe opioid agonist treatments. The Health Canada requirement for practitioners to obtain an exemption under subsection 56(1) of the Controlled Drugs and Substances Act (CDSA) to prescribe and administer methadone no longer exists effective May 19, 2018, however, the education and training requirements for British Columbia will remain the same.

In BC, the approach to monitoring, prevention, and intervention related to pharmaceutical opioid-associated harms has been collaborative and multi-sectoral. The College of Pharmacists, the College of Physicians and Surgeons, and the College of Registered Nurses of BC provide essential regulatory functions for maintaining a coordinated response to prevent against, identify early and respond to prescription opioid-related harms.

While the BCCSU is mandated to provide the OAT education, training and clinical care guidance for prescribers, the Colleges will continue to regulate health professionals to ensure patient safety is not compromised (i.e. unsafe prescribing practices).

WHO SHOULD TAKE THIS COURSE?

The online training for the Provincial Opioid Addiction Treatment Support Program is geared towards opioid agonist treatment prescribers, including both physicians and nurse practitioners, however, all health care providers (e.g., nurses, pharmacists, social worker, counsellors, etc.) can benefit from the online education modules.

Opportunities for CME credits (includes both MainPro+ and MOC credits)

PROGRAM OUTCOMES

Provide a primarily online-based education curriculum to train physicians and nurse practitioners in British Columbia to diagnose and treat opioid use disorder using evidence-based treatments along a continuum of care.

Learners can select modules based on their learning goals pertaining to methadone, buprenorphine/naloxone, SROM, iOAT, or a combination of these treatments options.

At the end of the course, you will be able to:

Define and establish a diagnosis opioid use disorder

Evaluate a patient with opioid use disorder and create a patient-centred care plan

EDUCATION REQUIREMENTS

The below requirements apply to both physicians and nurse practitioners who prescribe OAT.

On June 16, 2017, the College of Registered Nurses of British Columbia (CRNBC) approved new Nurse Practitioner Standards, Limits and Conditions that set out the requirements for both induction (initiation) and continuation/maintenance prescribing of opioid agonist treatment for opioid use disorder. With the standards, limits and conditions now fully in effect, it’s important to note the specific educational requirements and process to be able to prescribe these medications.

Oral Opioid Agonist Treatment Training

The process to meet the requirement for full oral OAT prescribing involves:

2 half-days of in-person preceptorship and any additional learning as needed

Injectable Opioid Agonist Treatment (iOAT)

Before prescribing iOAT, all prescribers are required to complete the oral opioid agonist treatment education and training as outlined above. The following are the education and training requirements to prescribe iOAT:

Complete the iOAT training stream (2 hours) in the POATSP

Submit the Preceptorship Form to the BCCSU

Complete 1 half-day with an iOAT preceptor, the supplemental iOAT workbook, and any additional training as per the discretion of the preceptor

The BCCSU will provide a copy of the Collaborative Prescribing Agreement to be signed and sent to the BC Ministry of Health

Important Note: All clinicians who wish to prescribe iOAT for opioid use disorder will need to complete a Collaborative Prescribing Agreement (CPA) that will be jointly signed by the BCCSU and prescriber and subsequently sent to the Ministry of Health for activation in PharmaNet. Any questions on this process can be sent to bccsu_education@bccsu.ubc.ca.

Buprenorphine/Naloxone (Required for Nurse Practitioners Only)

Nurse practitioners who only prescribe buprenorphine/naloxone for the treatment of opioid use disorder must complete the following requirements:

Register as a General Learner in the Provincial Opioid Addiction Treatment Support Program

Complete the buprenorphine/naloxone stream (4 hours)

Submit the Preceptorship Form to the BCCSU

Complete 2 half-days of preceptorship, complete the relevant workbook cases (see Figure 1 for details) and additional learning as per the discretion of the preceptor

Upon successful completion of the above requirements, a signed proof of completion letter will be sent to the respective nurse practitioner. NPs should refer to CRNBC’s Scope of Practice document for additional information on standards, limits and conditions from the regulator.

Applicants must select a name from the list of approved preceptors that is provided upon completion of the online modules of the Provincial Opioid Addiction Treatment Program and contact the chosen preceptor’s office directly to confirm availability. The applicant must report the scheduling of this preceptorship through an online survey-tool (links provided after completion).

Applicants must print out and complete either the Hospital-Based or Community- Based Case Workbook before the scheduled preceptorship. This workbook will be reviewed together with the preceptor throughout the two half-day sessions.

During the two half-day sessions, the preceptor will be required to complete a review of the workbook, ensure the diversion agreement is signed, and provide the BCCSU with their assessment of whether or not to recommend the provider to prescribe opioid agonist treatment in BC. This will be done through a secure online form sent to the BCCSU directly by the preceptor.

The BCCSU will then contact the applicant regarding successful or unsuccessful completion of the preceptorship and to address any concerns brought forth in the preceptorship.

Clinical Care Guidelines

All opioid agonist treatment prescribers should read and align their clinical practice to the following guidelines and support tools when practicing in the province of British Columbia:

For prescribers who intend to take on this more advanced prescribing, there is a specific module available in the online course to support your practice. It is also recommended that clinicians complete a preceptorship with a preceptor who has specific experience with that medication. When scheduling a preceptorship, the list of preceptors also includes which medications they routinely prescribe.

Preceptors will assist in the training and mentoring of new prescribers. The BCCSU has developed a process to select preceptors across the province (i.e. each health authority) to ensure adequate coverage to meet the needs for recruiting new prescribers, including nurse practitioners.
BCCSU preceptors must meet the following criteria:

At least three years’ experience in the Methadone Maintenance Program with minimum 20 registered patients and a practice that includes routine inductions

Preceptors will be provided with comprehensive training regarding their role and responsibilities. Further, preceptors will be compensated $200 per half-day of teaching and for training sessions required by the BCCSU.

The Health Canada requirement for practitioners to obtain an exemption under subsection 56(1) of the Controlled Drugs and Substances Act (CDSA) to prescribe and administer methadone has been removed, effective May 19, 2018. The Canadian Research Initiative in Substance Misuse (CRISM) conducted a broad consultation on the section 56 exemption requirement, and stakeholders indicated that removing the requirement would “normalize” methadone treatment and help reduce the stigma associated with treatment for substance use disorders.
It is important to note that while the Health Canada exemption processing will no longer exist after this date, the education and training requirements for British Columbia will remain the same.